Tag Archives: inflammation

Dairy Intolerance (Lactose, Casein and Whey)

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Do you have a dairy intolerance? An allergy? What’s the difference? How can you even tell?

And if you do, what should you do about it?

Don’t worry – I have you covered in my newest post.

Having a food intolerance is not fun. It can cause abdominal pain, discomfort, and nausea. It also causes embarrassing symptoms like flatulence and diarrhea. Other symptoms linked to food intolerances include muscle or joint pain, headaches, exhaustion, and even skin symptoms like rashes and eczema.

Dairy is just one of those foods that many people seem to be intolerant of. Let’s talk about the main components of milk that people react to: lactose, casein, and whey.

Milk sugar (lactose) intolerance

It’s estimated that up to 75% of adults are lactose intolerant. Lactose is the carbohydrate “milk sugar” naturally found in most dairy products. Lactose intolerance is so common you can buy lactose-free milk in your regular grocery store. Lactose-free products are treated with the enzyme “lactase” that breaks the lactose down before you ingest it. It’s this lactase enzyme that is lacking in most people who are lactose intolerant.

The lactase enzyme is naturally released from your intestine as one of your digestive enzymes. It breaks down the lactose sugar in the gut. When someone doesn’t have enough lactase, the lactose doesn’t get broken down the way it should.  Undigested lactose ends up being food for the resident gut microbes. As they ferment the lactose, they create gases that cause bloating, flatulence, pain, and sometimes diarrhea.

Lactose is in dairy but is in lower amounts in fermented dairy (e.g. cheese & yogurt) and butter. Steering clear of lactose isn’t that easy as it is added to other foods like baked goods, soups, and sauces. And if you’re taking any medications or supplements, check to see if it’s in there too, as lactose is a common ingredient in them.

If you have symptoms of lactose intolerance, keep an eye on food, medication, and supplement labels.

Milk protein (casein & whey) allergy

Milk is a known, and common, food allergen. In Canada, it is considered a “priority allergen” and must be declared on food labels.

So, what are the allergens in milk? You’ve heard of “curds and whey?” Well, these are the two main proteins in milk. The solid bits are the curds (made of casein), and the liquid is the dissolved whey.

Unlike lactose intolerance, casein and whey can cause an actual immune response. It’s an allergy. And this immune response can cause inflammation. In fact, we don’t know how many people have these milk allergies, but most estimates put it far below that of lactose intolerance.

Like lactose, these allergenic milk proteins can be found in other products too. They’re not just in dairy but are often in protein powders as well (Have you heard of “whey” protein powders?).

Some of the symptoms of milk protein allergy differ from that of lactose intolerance; things like nasal congestion and mucus (phlegm) are more common here. And casein seems to be linked with belly fat.

Interestingly, people who have gluten intolerance are often allergic to milk proteins like whey and casein as well. These can go hand-in-hand.

Like lactose intolerance, if you’re allergic to casein and whey keep an eye on labels so you can avoid these.

Conclusion

If you get gassy, bloated, or diarrhea after eating dairy, you may have a lactose intolerance. If you often get a stuffy nose and mucus, then you may be allergic to casein and/or whey.

While dairy may be an entire food group, it is not an essential nutrient. All the nutrients in dairy are available in other foods. If you experience these symptoms, you can try removing dairy from your diet. You may find improved digestion and fewer gut issues. Or you may find improved nasal congestion, or even less belly fat.

If you decide to (or have already) removed dairy from your diet, let me know your experience in the comments below.

References available on request

Yep, you gotta read the small print, its important:

Disclaimer

The information contained herein is NOT intended as medical advice, nor is it intended to replace the care of a qualified health professional. Always consult your doctor for all diagnoses, treatments, and cures for any diseases or conditions, as well as before changing your health care regimen.

Can My Symptoms Actually Be A Food Intolerance?

white and brown cooked dish on white ceramic bowls
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Do you have symptoms that just don’t seem to go away?

One of the trickiest things to figure out is whether a random symptom could be due to a food intolerance. That’s because symptoms can be delayed, or ongoing, and not even resemble a gastrointestinal symptom at all.

In this post, I go over a few of the common symptoms, and two (very) common foods that you may be reacting to, but don’t even know it.

Food intolerance or “sensitivities” can affect you in so many ways.

And they’re a lot more common than most people think.

I’m not talking about anaphylaxis or immediate allergic reactions that involve an immune response. Those can be serious and life-threatening.  If you have any allergies, you need to steer clear of any traces of foods you are allergic to, and speak with your doctor or pharmacist about emergency medication, if necessary.

What I’m talking about, is an intolerance, meaning you do not tolerate a specific food very well and it causes immediate or chronic symptoms anywhere in the body. Symptoms can take hours or even days to show themselves. And symptoms can be located just about anywhere in the body.

This is what makes them so tricky to identify.

The Metabolic Balance® program takes into consideration individual food allergies and food sensitivities when developing a personalized nutrition plan.  You can read more on the program here.

Symptoms of food intolerance

There are some common food intolerances that have immediate and terribly painful gastrointestinal symptoms, such as lactose intolerance or celiac disease. These can cause stomach pain, gas, bloating, and/or diarrhea;  symptoms can start immediately after eating lactose or gluten.

On the other hand, other more insidious symptoms may not be linked to foods in an obvious way.

Symptoms like:

  • Chronic muscle or joint pain
  • Sweating, or increased heart rate or blood pressure
  • Headaches or migraines
  • Exhaustion after a good night’s sleep
  • Autoimmune conditions like Hashimoto’s or rheumatoid arthritis
  • Rashes or eczema
  • Inability to concentrate or feeling like your brain is “foggy”
  • Shortness of breath

If your body has trouble digesting specific foods, it can affect your hormones, metabolism, or even cause inflammation and result in any of the symptoms listed above. And these can affect any (or all) parts of the body, not just your gastrointestinal system.

How to restrain these intolerances

The main thing you can do is to figure out which foods or drinks you may be reacting to and stop ingesting them.

I know, I know…this sounds so simple, and yet it can be SO HARD.

The best way to identify your food/drink triggers is to eliminate them.

Yup, get rid of those offending foods/drinks. All traces of them, for three full weeks and monitor your symptoms.

If things get better, then you need to decide whether it’s worth it to stop ingesting them, or if you want to slowly introduce them back one at a time while still looking out to see if/when symptoms return.

Start Here: Two common food intolerances

Here are two of the most common triggers of food intolerance:

  • Lactose (in dairy – eliminate altogether, or look for a “lactose-free” label – try nut or coconut milk instead).
  • Gluten (in wheat, rye, and other common grains – look for a “gluten-free” label – try gluten-free grains like rice, quinoa & gluten-free oats).

This is by no means a complete list, but it’s a good place to start because lactose intolerance is thought to affect up to 75% of people, while “non-celiac gluten sensitivity” can affect up to 13% of people.

So, if you can eliminate all traces of lactose and gluten for three weeks, it can confirm whether either or both of these, are a source of your symptoms.

Yes, dairy and grains are a part of many government-recommended food guidelines, but you absolutely can get all of the nutrients you need if you focus on replacing them with nutrient-dense foods.

A reliable way to monitor how you feel after eating certain foods is to track it. After every meal or snack, write down the foods you ate, and any symptoms so you can more easily spot trends.

If you are interested in receiving a free copy of my weekly Diet Diary/Food Journal to help you keep track, email me tessanp@shaw.ca and I will send it along.

And, as mentioned earlier, symptoms may not start immediately following a meal. You may find, for example, that you wake up with a headache the morning after eating bananas.

You might be surprised what links you can find if you track your food and symptoms well!

IMPORTANT NOTE: When you eliminate something, you need to make sure it’s not hiding in other foods, or the whole point of eliminating it for a few weeks is lost. Restaurant food, packaged foods, and sauces or dressings are notorious for adding ingredients that you’d never think are there. You know that sugar hides in almost everything, but did you also know that wheat is often added to processed meats and soy sauce, and lactose can even be found in some medications or supplements?

When in doubt you HAVE to ask the server in a restaurant about hidden ingredients, read labels, and consider cooking from scratch.

What if it doesn’t work?

If eliminating these two common food intolerances doesn’t work, then you can go one step further to eliminate all dairy (even lactose-free) and all grains (even gluten-free) for three weeks.

You may need to see a qualified healthcare practitioner for help, and that’s OK. I don’t want you to continue suffering if you don’t need to!

References available on request
Yep, you gotta read the small print, its important:
Disclaimer
The information contained herein is NOT intended as medical advice, nor is it intended to replace the care of a qualified health professional. Always consult your doctor for all diagnoses, treatments, and cures for any diseases or conditions, as well as before changing your health care regimen.

Omega 3s-The Fats We Love

fish 2

Omega-3s get a lot of notoriety – and for good reason! Not only is one of them essential for good health, but we don’t get enough of them in our diets.

Omega-3s are a kind of fat. Fats are not just a storable source of 9 calories per gram. Different fats are used by our bodies for different essential functions. They’re part of the membranes that surround each cell, and are especially important in the brain and nerves.

They can mediate the effect of our immune cells as well as influence the production of neurotransmitters and hormones. Omega-3s are anti-inflammatory, and have health benefits for the heart, brain, and our mental health.  They are even needed for skin health!

In fact, it’s thought that the reduced intake of omega-3s over the last few generations is one of the reasons for the increase in many of the chronic diseases we see today.

In this conversation, we’ll take a closer look at the anti-inflammatory component and how to get Omega 3 from food.

Let’s look at what exactly omega-3s are, why they’re so good for our health, and how to get enough of these lovable fats.

What are omega-3s?

There are several types of fats (a.k.a. fatty acids). They’re broken down into two main categories: saturated and unsaturated. Unsaturated fatty acids are further broken down into monounsaturated (MUFAs) and polyunsaturated (PUFAs).

The main types of PUFAs are omega-3s and omega-6s. We don’t hear much about omega-6s because we tend to get too much of these in our diet already. Omega-6s are found in meat, poultry, and many common seed oils like corn and sunflower. So, the focus has been to educate people to swap out some of those omega-6s to get more omega-3s like our ancestors did.

Three of the omega-3 fatty acids are particularly important for health. They are:

  • Alpha-linolenic acid (ALA) – essential fatty acid
  • Eicosapentaenoic acid (EPA) – biologically active fatty acid
  • Docosahexaenoic acid (DHA) – biologically active fatty acid

ALA is essential – literally essential for health, just like essential vitamins and minerals. This is because the body can’t create it from other nutrients. It is this omega-3 that the body needs in order to create the biologically active EPA and DHA. In fact, research shows that the primary role of ALA is to be the building block for EPA and DHA.

What I mean by “biologically active” is that EPA and DHA are the forms of omega-3s that provide the health benefits. They’re the ones that are active in the body.

ALA is the plant-based omega-3 and is found in many seeds like flax, hemp, and chia. It’s also found in walnuts, and oils from olives, canola, and soy.

EPA and DHA, on the other hand, are found in seafood, especially oily fish. They are also found in algae, which is a vegetarian source.

FUN FACT: Fish have the biologically active forms of omega-3s because they eat the algae and store extra EPA and DHA in their fat.

The conversion of plant-based essential ALA into the biologically active EPA and DHA is complex and requires several steps and enzymes. Unfortunately, the process isn’t very efficient. The conversion rate of ALA to EPA is about 8-12%, while the conversion to DHA is only about 1%. Some studies show that women may have slightly higher conversion rates compared to men.

Despite all of this biochemistry, the real question is how do they work in the body and what are these health benefits?

The health benefits of omega-3s

There is a lot of research about the health benefits of omega-3 fatty acids. Things like anti-inflammation, heart and brain health, as well as better moods.  They’re even good for our skin!

Omega-3s and anti-inflammation

There are many inflammatory diseases like allergies, asthma, arthritis, and autoimmune diseases. There are also many other diseases that may not be inflammatory per se, but have a substantial inflammatory component. These include diabetes, obesity, cancer, heart disease, depression, and neurodegenerative diseases such as Alzheimer’s.

Many of these conditions are becoming more common. Reasons include allergens, infections, environmental and dietary toxins, and even stress. As mentioned earlier, one of these reasons is our inflammatory diets.

Yes! What you eat can increase or decrease the amount of inflammation in your body.

An inflammatory diet contains a much higher intake of omega-6s compared with omega-3s. In fact, the higher the intake of certain omega-6s, the higher the production of certain inflammatory molecules.

Many animal and some clinical studies have found reduced inflammation when omega-3 supplements were taken.

A review of 30 studies showed that fish oil supplements reduced the pain of arthritis, particularly rheumatoid arthritis.

How do omega-3s reduce inflammation?

Two ways. First, they are used to create anti-inflammatory molecules themselves. Second, they can inhibit some of the mechanisms that cause inflammation in the first place.

Omega-3s are used to produce certain anti-inflammatory molecules (e.g. prostaglandins, resolvins, etc.) that combat inflammation.

They also reduce the production of enzymes that create inflammatory molecules, and can even reduce the expression of certain inflammatory genes.

Omega-3s become incorporated into the membranes of immune cells and affect their inflammatory response.

Some animal studies even show that omega-3s can reduce inflammation by helping to reduce obesity!

How to get enough omega-3s from food

In order to get the health benefits you have to regularly eat enough foods that are high in omega-3s.

It’s thought that our ancestral diets included approximately equal amounts of omega-3s and omega-6s. Now, our intake of omega-6s is up to 20x higher than our intake of omega-3s. This is why there is such an emphasis on getting enough omega-3s.

When it comes to plant-based sources of omega-3s, flax is the winner! Up to half of flax’s total fatty acids are the essential omega-3 ALA. Canola, walnuts, and soy, are less concentrated sources of ALA, with about 10% of their fatty acids as ALA.

To eat the recommended amount of omega-3s have at least two servings of fatty fish each week. Fatty fish include salmon, mackerel, herring, and sardines. This is a recommendation from the World Health Organization, as well as other health authorities.

In the US, there have been consistent recommendations to increase fish intake for almost 20 years. Despite this the average American still only eats about 1.3 servings of fish per week.

Eating fish and seafood gives you a lot more nutrition than simply taking a supplement. They contain protein, vitamins D and B12, as well as the minerals iodine, selenium, potassium, and magnesium, to name a few.

When it comes to choosing fish, bigger is not better! Large fish that feed on smaller fish have higher concentrations of toxins in their fat. To reduce your intake of things like methyl mercury and organic pollutants, limit your intake of tilefish, king mackerel, shark, and swordfish. And anyone who is pregnant, breastfeeding, or a child, should avoid these types of fish altogether.

There are also non-fish sources of omega-3s! Some foods are fortified with omega-3 oils. Some baked goods, pastas, dairy, eggs, dressings, and spreads may contain added flax, algal, or fish oils. Omega-3 eggs are produced by hens who’ve had flax seeds, chia seeds, and/or fish oil added to their feed. In fact, hens fed the plant-based ALA produce eggs with ALA, and those fed fish oil produced eggs with EPA & DHA.

Check your labels!

Next time I’ll talk about Omega 3s and brain health and what to do if you are not getting enough Omega 3s in your diet.

 

 

References available on request

 

 

Important small print you must read:

Disclaimer

The information contained herein is NOT intended as medical advice, nor is it intended to replace the care of a qualified health professional. Always consult your doctor for all diagnoses, treatments, and cures for any diseases or conditions, as well as before changing your health care regimen.

Is a good night’s sleep the stuff of dreams?

white fabric blanket
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Oh, that elusive sleep.  That time to relax and regenerate.  To heal and repair.

Sleep isn’t just important for your mind and body to have energy and be alert.  Lack of sleep can contribute to serious health issues which you don’t want.

So let me have your attention for this “tip-filled” post on the importance of sleep and how you can get your fair share.  I’ll even throw in an amazing caffeine-free latte recipe for your afternoon “pick me up”.

The science of sleep is fascinating, complicated and growing

Sleep is this daily thing that we all do and yet we’re just beginning to understand all of the ways it helps us and all of the factors that can affect it.

Lack of sleep affects just about everything in your body and mind.  People who get less sleep tend to be at higher risk for so many health issues like diabetes, heart disease, and certain types of cancer; not to mention effects like slower metabolism, weight gain, hormone imbalance, and inflammation.

Recent studies have provided evidence that there is a direct relationship between inadequate sleep of less than 6 hours per day and increased body mass index in both adults and children.¹

The risk of being overweight or obese is greatly increased in short sleepers – by 50% in the case of men and 34% in the case of women.¹

So, it’s important to be reminded that there is a reciprocal relationship between sleep and nutrition: the better your diet, the better you sleep.   And the better you sleep, the less likely you are to consume foodstuffs that might result in increased weight.¹

This is why the Metabolic Balance® plan develops personalized dietary plans to match the metabolic requirements profile of each individual client.  You can learn more by viewing this brief introductory video  https://m.youtube.com/watch?v=p1H7LUmulJM or contact me at tessanp@shaw.ca

And don’t forget the impact lack of sleep can have on moods, memory and decision-making skills.

In addition, lack of sleep may even negate the health benefits of your exercise program? (Gasp!)

OMG – What aspect of health does sleep not affect???

Knowing this it’s easy to see the three main purposes of sleep:

  • To restore our body and mind. Our bodies repair, grow and even “detoxify” our brains while we sleep.
  • To improve our brain’s ability to learn and remember things, technically known as “synaptic plasticity”.
  • To conserve some energy so we’re not just actively “out and about” 24-hours a day, every day.

Do you know how much sleep adults need?  It’s less than your growing kids need but you may be surprised that it’s recommended that all adults get 7 – 9 hours a night.  For real!

Try not to skimp!

(Don’t worry, I have you covered with a bunch of actionable tips below.)

Tips for better sleep

  • The biggest tip is definitely to try to get yourself into a consistent sleep schedule. Make it a priority and you’re more likely to achieve it.  This means turning off your lights 8 hours before your alarm goes off.  Seven. Days. A. Week.  I know weekends can easily throw this off but by making sleep a priority for a few weeks your body and mind will adjust and thank you for it.
  • Balance your blood sugar throughout the day. You know, eat less refined and processed foods and more whole foods (full of blood-sugar-balancing fiber).  Choose the whole orange instead of the juice (or orange-flavoured snack).  Make sure you’re getting some protein every time you eat. If you want to know which foods are right for you check out the Metabolic Balance® program right here or contact me at tessanp@shaw.ca
  • During the day get some sunshine and exercise. These things tell your body it’s daytime; time for being productive, active and alert.  By doing this during the day it will help you wind down more easily in the evening.
  • Cut off your caffeine and added sugar intake after 12pm. If you want to know why read my post about the effects of caffeine. Whole foods like fruits and veggies are fine, it’s the “added” sugar we’re minimizing.  Yes, this includes your beloved chai latte.  Both caffeine and added sugar can keep your mind a bit more active than you want it to be right into the evening hours. (HINT: I have a great caffeine-free chai latte recipe for you below!).
  • Have a relaxing bedtime routine that starts 1 hour before your “lights out” time (that is 8 – 10 hours before your alarm is set to go off). This would include dimming your artificial lights, nixing screen time and perhaps reading an (actual, not “e”) book or having a bath.

So how many of these tips can you start implementing today?

And for the recipe:

Recipe (Caffeine-free latte for your afternoon “coffee break”): Caffeine-Free Chai Latte

Serves 1-2

1 bag of rooibos chai tea (rooibos is naturally caffeine-free)

2 cups of boiling water

1 tablespoon tahini

1 tablespoon almond butter (creamy is preferred)

2 dates, pitted (optional)

Cover the teabag and dates (if using) with 2 cups of boiling water and steep for a few minutes.

Discard the tea bag & place tea, soaked dates, tahini & almond butter into a blender.

Blend until creamy.

Serve and Enjoy!

Tip:  You can try this with other nut or seed butters to see which flavour combination you like the best.  Cashew butter anyone?

Allergy alert: Please do not consume if you have an allergy or sensitivity to any of the ingredients listed.

References:

http://www.precisionnutrition.com/hacking-sleep

¹ Metabolic Balance® interesting facts about medicine and nutrition. Obesity and sleep – how are they related?

 

 

Important small print you must read:
Disclaimer
The information contained herein is NOT intended as medical advice, nor is it intended to replace the care of a qualified health professional. Always consult your doctor for all diagnoses, treatments, and cures for any diseases or conditions, as well as before changing your health care regimen.

Why your waist circumference matters.

appetite apple close up delicious
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You totally want to ditch your scale, don’t you?

You may have this weird kind of relationship with your “weight”.

I mean, it doesn’t define you (obviously).

What you weigh can matter but only to a certain extent.

Let’s look at your waist circumference (well…you look at yours and I’ll look at mine).

Just like my friend did and was pretty upset to learn that her waist circumference put her at higher risk of some serious health issues.  “But how can that be” she said to me, “my weight is within the normal range?”

Waist Circumference (AKA “Belly Fat”):

Do you remember the fruity body shape descriptions being like an “apple” or a “pear”?  The apple is round around the middle (you know – belly fat-ish, beer belly-ish) and the pear is rounder around the hips/thighs.

THAT is what we’re talking about here.

Do you know which shape is associated with a higher risk of sleep apnea, blood sugar issues (e.g. insulin resistance and diabetes), and heart issues (high blood pressure, blood fat, and arterial diseases).

Yup – that apple!

And it’s not because of the subcutaneous (under the skin) fat that you may refer to as a “muffin top”.  The health risk is actually due to the fat inside the abdomen covering the liver, intestines and other organs there.

This internal fat is called “visceral fat” and that’s where a lot of the problem actually is.  It’s this “un-pinchable” fat.

The reason the visceral fat can be a health issue is because it releases fatty acids, inflammatory compounds, and hormones that can negatively affect your blood fats, blood sugars, and blood pressure.

According to an article written by Silvia Burkle, Food Technologist and co-developer of the Metabolic Balance® nutritional concept, excess visceral abdominal fat puts us at higher risk of chronic inflammatory diseases.

Ms. Burkle goes on to say that the cause of to much abdominal fat is not an uneven energy balance alone, in other words it’s not necessarily about the number of calories ingested exceeding the calories that are expended.  A study published in the Journal of Nutrition, for example, showed that a diet with a very high proportion of carbohydrates and a simultaneous reduction of the protein content, especially the essential amino acids, may lead to more abdominal fat¹.

And the apple-shaped people tend to have a lot more of this hidden visceral fat than the pear-shaped people do.

So as you can see where your fat is stored is more important than how much you weigh.

Am I an apple or a pear?

It’s pretty simple to find out if you’re in the higher risk category or not. The easiest way is to just measure your waist circumference with a measuring tape.  You can do it right now.

Women, if your waist is 35” (88cm) or more you could be considered to have “abdominal obesity” and be in the higher risk category.  Pregnant ladies are exempt, of course.

For men the number is 40” (102cm).

Of course this isn’t a diagnostic tool.  There are lots of risk factors for chronic diseases.  Waist circumference is just one of them.

If you have concerns definitely see your doctor.

Tips for helping reduce some belly fat:

  • Eat more fiber. Fiber can help reduce belly fat in a few ways.  First of all it helps you feel full and also helps to reduce the amount of calories you absorb from your food.  Some examples of high-fiber foods are brussel sprouts, flax and chia seeds, avocado, and blackberries.
  • Add more protein to your day. Protein reduces your appetite and makes you feel fuller longer.  It also has a high TEF (thermic effect of food) compared with fats and carbs and ensures you have enough of the amino acid building blocks for your muscles. If you are unsure about how much protein to eat contact me at tessanp@shaw.ca for more information, I can help.
  • Nix added sugars. This means ditch the processed sweetened foods especially those sweet drinks (even 100% pure juice).
  • Move more. Get some aerobic exercise.  Lift some weights.  Walk and take the stairs.  It all adds up.
  • Stress less. Seriously!  Elevated levels in the stress hormone cortisol have been shown to increase appetite and drive abdominal fat.
  • Get more sleep. Try making this a priority and seeing how much better you feel (and look). 

 

 

 

References

¹Donald K. Layman et al.: A reduced ratio of Dietary carbohydrate to Protein improves Body composition and blood lipid profiles during weight loss in adult women. Journal of Nutrition 2003; vol. 133 no 2 411-417

http://www.precisionnutrition.com/research-abdominal-fat-and-risk

http://www.precisionnutrition.com/visceral-fat-location

http://www.drsharma.ca/inspiring-my-interest-in-visceral-fat

https://www.hsph.harvard.edu/obesity-prevention-source/obesity-definition/abdominal-obesity/

http://www.hc-sc.gc.ca/fn-an/nutrition/weights-poids/guide-ld-adult/qa-qr-pub-eng.php#a4

https://authoritynutrition.com/6-proven-ways-to-lose-belly-fat/

https://authoritynutrition.com/20-tips-to-lose-belly-fat/

 

 

Important small print you must read:
Disclaimer
The information contained herein is NOT intended as medical advice, nor is it intended to replace the care of a qualified health professional. Always consult your doctor for all diagnoses, treatments, and cures for any diseases or conditions, as well as before changing your health care regimen.